Health Law

Congress Continues Game of Political Football with Medicare "Doc Fix"

Posted on June 23, 2010
As of this past Friday, things were looking good for at least a temporary fix to the impending 21% Medicare physician rate cuts.  In an effort to forestall the cuts, the Senate passed a short term fix and sent it back to the House of Representatives for a vote...

Senate Passes Short Term Medicare Physician Fee Fix

Posted on June 21, 2010
On Friday, June 18, the Senate approved a bill which, if passed by the House next week, would prevent the scheduled 21% cut in Medicare reimbursement under the Medicare Physician Fee Schedule.  The bill would provide for a 2.2% increase over 2009 rates but only until November 30, 2010...

Medicare Physician Fee Schedule "Doc Fix" Not Looking Good

Posted on June 16, 2010
The Senate voted down a bill this week that would have temporarily avoided the impending 21% cuts in Medicare physician fees.  Although those cuts technically took effect on June 1, 2010, the Centers for Medicare and Medicaid put a hold on physician payments until tomorrow to give Congress time to pass the legislation...

Selling Your Medical Practice to a Hospital - Webinar

Posted on June 14, 2010
On May 20, we presented a free Webinar to physicians and other interested parties regarding practical tips and key legal issues to be considered in selling a medical practice to a hospital.  if you weren't able to attend and are still interested in listening, you can listen to the recorded webinar by clicking here...

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Now this is what I call fraud ...

Posted on May 28, 2010
Five California physicians are among the eleven individuals indicted by a federal grand jury on May 20, 2010 for Medicare fraud. The scheme allegedly involved runners who were paid by the number of patients brought to the clinics, claims in excess of $5 million for nonexistent or medically unnecessary services, payments to "patients" for the use of their Medicare numbers, claims for services rendered to deceased beneficiaries, and fabrication of test results, sometimes from tests staffers performed on each other...

Law Suspending Medicare Physician Payment Cuts Is Close

Posted on May 21, 2010
According to a recent article on Politico, federal lawmakers are close to passing legislation that would suspend until 2014 the 21% Medicare Physician Fee Schedule cuts that have been hanging over physicians' heads since January.  According to the article, under the bill physician payments would increase by 1...

Considering Selling Your Medical Practice to a Hospital?

Posted on May 10, 2010
If you are one of the many doctors in private practice thinking about selling your medical practice, consider signing up for our free one-hour Webinar "Selling Your Medical Practice to a Hospital: Legal and Practical Considerations".  The Webinar, which will be held Thursday, May 20, 2010 from 12 - 1 p...

Medicare Physician Payment Cuts Delayed Until June 1, 2010

Posted on April 16, 2010
The dreaded 21% Medicare Physician Fee Schedule payment cuts were, after several extensions, scheduled to take effect yesterday, April 15, 2010.  The Senate passed last minute legislation, however, delaying the effective date of those cuts until June 1, 2010, and the President quickly signed the legislation into law last night...

States Look to Expand Role of Nurse Practitioners

Posted on April 15, 2010
As if physicians didn't already have enough to worry about, it appears that many states are now contemplating expanding the scope of practice of nurse practitioners.  According to recent AP article, at least 28 states are looking at expanding the scope of services nurse practitioners can provide as a means of addressing the looming shortage of primary care physicians expected as a result of the recently enacted health reform law...

The Race to Complete Physician-Owned Hospitals Is On

Posted on April 09, 2010
  For physicians in the process of developing physician-owned hospitals, the race is on to get those facilities up and running by December, 2010. The recently enacted 'Health Care and Education Affordability Reconciliation Act of 2010' amends the Stark law to once and for all prohibit physician-owned specialty hospitals unless: (1) the hospital has a Medicare provider agreement by December 31, 2010; and (2) was not converted from an ambulatory surgical center to a hospital after March 23, 2010...

New Requirements on Stark In-Office Ancillary Services

Posted on April 08, 2010
Among its many provisions, the newly signed Patient Protection and Affordable Care Act has imposed a new requirement on physicians who rely on the Stark "In-Office Ancillary Services" exception.  Physicians who refer patients for CT, MRI or PET (or other Stark services as designated by the Secreatary of HHS) that will be provided by the referring physician's practice under the Stark In-Office Ancillary Services exception must now inform the patient in writing at the time of the referral that the individual may obtain the services for which the individual is being referred from a person other than the referring physician's practice, and provide the patient with a written list of suppliers (who furnish such services in the area in which such individual resides...

Advanced Imaging Suppliers To be Accredited by January 2012

Posted on March 09, 2010
Under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), all Medicare suppliers of the technical component of advanced imaging services have until by January 1, 2012 to become accredited by an accreditation organization designated by the Secretary of Health and Human Services ...

2010 Medicare Fee Cuts Delayed - Again

Posted on March 04, 2010
On Tuesday night, President Obama signed into law the 'Temporary Extension Act of 2010' - a bill extending various benefits to unemployed Americans.  Physicians across the country can collectively breathe a sigh of relief as the new law includes a provision delaying implementation of the 2010 Medicare physician fee schedule which includes a 21% across the board cut in Medicare reimbursement to physicians...

CMS Delays Physician Payments to Allow Medicare Fee Fix

Posted on March 02, 2010
In an effort to give Congress a few more days to pass legislation postponing the 2010 Medicare Physician Fee Schedule payment cuts, CMS has once again instructed its contractors to hold physician claims for the first 10 days of March for claims with dates of service March 1, 2010 and later...

House Quietly Repeals Insurance Anti-trust Exemption

Posted on February 25, 2010
In what should be welcome news for physicians, yesterday the House of Representatives quietly passed a bill which would repeal a long-standing exemption for insurance companies from federal anti-trust laws.  The exemption left anti-trust enforcement against insurance companies in the hands of the states...

President Obama Unveils Comprehensive Health Plan

Posted on February 22, 2010
In anticipation of a much publicized bipartisan meeting with representatives of Congress, President Obama released today a comprehensive health plan which seeks to combine the House and the Senate health care bills. The President's proposal, which can be read on the Whitehouse...

Philadelphia Chiropractor Charged in Alleged Health Care Fraud Scheme

Posted on February 22, 2010
According to an article in the Philadelphia Inquirer over the weekend, a total of 83 in the Philadelphia area have been charged in connection with an alleged scheme to stage automobile accidents and file false claims for insurance benefits. The latest people charged include a Philadelphia chiropractor and an attorney...

CMS a Slow Payer?

Posted on February 12, 2010
Physicians, Wondering why cash is a little tighter in 2010?  In case you hadn't heard, the Centers for Medicare and Medicaid Services (CMS) instructed its contractors to put a 10 day hold on physician payments at the beginning of January.  Here's what's going on:  On October 30, 2009, CMS released the 2010 Medicare Physician Fee Schedule which included a 21...

White House Steps Up Efforts to Curb Health Care Fraud

Posted on January 29, 2010
According to a PR Newswire article today, the White House intends to significantly increase efforts to curb health care fraud and abuse.  At the National Summit on Health Care Fraud this week, Secretary of Health and Human Services, Kathleen Sebelius announced that President Obama's FY 2011 Budget is expected to include historic support for anti-fraud efforts focusing on programs that have successful in preventing fraud and reducing payment errors...

Medicare Eliminates Consult Codes

Posted on January 19, 2010
In case you missed it, the Centers for Medicare and Medicaid Services (CMS) eliminated use of the evaluation and management Consultation Codes.  Consultations are now to be billed using the standard E/M visit codes.  According to CMS Transmittal 1875: "Effective January 1, 2010, the consultation codes are no longer recognized for Medicare Part B payment...

Hospital to Pay Feds Based on Improper Physician Arrangement

Posted on January 11, 2010
According to a Department of Justice Press Release, a Texas Hospital has agreed to pay the federal government close to a million dollars in settlement of allegations that the hospital violated the federal False Claims Act. Specifically, Arlington Memorial Hospital has agreed to pay the U...

Congressional Budget Offices Revises Estimated Savings from Tort Reform - Finds $50 Billion in Extra Savings

Posted on December 16, 2009
In a 2008 report, the the Congressional Budget Office estimated that the savings from tort reform would amount to only about $4 Billion over the period from 2010 to 2019.  However, acording to a letter dated December 10, 2009 to Senator Rockefeller, the CBO's original estimate failed to take into consideration that tort reform would result in lower utilization of services...

Amendments to Charges for Medical Records

Posted on December 08, 2009
The Pennsylvania Department of Health has published the amounts which may be charged by a health care facility or health care provider in Pennsylvania upon receipt of a request or subpoena for production of medical charts or records.  Effective January 1, 2010, the following fees may be charged by a health care facility or health care provider for production of records in response to subpoena or request: Not to Exceed Amount charged per page for pages 1—20 $ 1...

Use the Correct Modifier When Billing for Diagnostic Tests

Posted on December 08, 2009
According to a recent Transmittal from the Centers for Medicare and Medicaid Services, physicians and others are using modifier -PC to designate the "professional component" of diagnostic tests.  However, the -PC modifier is actually to be used to designate "Wrong Surgical or Other Invasive Procedure Performed on a Patient...

Medicare Physician Fee Reform May be on the Way

Posted on December 02, 2009
On November 24, 2009, the U.S. House of Representatives passed the Medicare Physician Payment Reform Act" (H.R. 3961) which would repeal the scheduled 21% fee reduction scheduled for January 2010.  The legislation would also permanently replace the existing Sustainable Growth Rate (SGR) formula with a new formula that, according to the House summary: Removes items such as drugs and laboratory services not paid directly to practitioners from spending targets; Allows spending on most services to grow at the rate of GDP plus 1 percentage point per year (compared to GDP without any adjustment today); Allows spending on primary and preventive care services to grow at GDP plus 2 percent per year; and Encourages coordinated, innovative care by allowing Accountable Care Organizations to be responsible for their own growth paths, irrespective of reductions or increases that apply elsewhere in the system...

President to Sign Executive Order to Curb Medicare Fraud

Posted on November 27, 2009
According to a report issued by the Office of Management and Budget (OMB) of the White House, the Federal government made $54 billion in improper payments in 2009 from the Medicare and Medicaid programs.  The OMB reports that in response, President Obama is expected to sign an Executive Order this week designed to boost inter-agency transparency, hold agencies accountable, and create incentives for compliance...

Senate Bill Would Strengthen Anti-Fraud Efforts

Posted on November 17, 2009
While all eyes are on the health care reform debate, a new Senate bill would give the government improved tools for investigating and prosecuting fraud and abuse in both federal and private health insurance programs. One of the most significant proposed changes would authorize a qui tam whistleblower action under the False Claims Act based solely on allegations of a violation of the Anti-Kickback law...

Texas Hospital System Settles Sham Lease/Directorship Claims for $27.5 Million

Posted on November 16, 2009
A cautionary tale for physicians who lease space or provide medical director services to hospitals.  These common arrangements are coming under increasing scrutiny, and must be commercially reasonable to withstand challenge.   McAllen Hospitals L...

Red Flag Rule Enforcement Date Extended to June 2010

Posted on November 03, 2009
According to a Federal Trade Commission (FTC) press release, the FTC is once again delaying the "Red Flag Rule" identity theft enforcement date.  In its current form, the Red Flag Rule could apply to many physician practices.  The new enforcement date is June 1, 2010...

West Penn Allegheny Antitrust Suit Dismissed

Posted on October 30, 2009
According to a recent article in the Pittsburgh Post-Gazette, West Penn Allegheny Health System's federal antitrust lawsuit against University of Pittsburgh Medical Center and Highmark Inc., has been dismissed.  Filed in April of this year, the lawsuit alleged that UPMC and Highmark conspired to raise prices and squeeze out competition...

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